分子分型预测子宫内膜癌及子宫内膜非典型增生患者保留生育功能治疗后的预后及生育结局OACSTPCD

Objective:To explore the impact of molecular classification on tumor prog-nosis and fertility outcomes among patients with endometrial carcinoma(EC)and atypical en-dometrial hyperplasia(AEH)who underwent fertility-preserving therapy.Methods:This study retrospectively collected clinical data on 95 patients with EC or AEH who received fertility-pre-serving treatment at the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2021.Immunohistochemistry(IHC)and Sanger sequencing were used to divide the patients into four subtypes based on proactive molecular risk classifier for endometrial cancer(ProMisE):POLE exonuclease domain mutation(POLE EDM),mismatch repair deficient(MMRd),p53 abnormal(p53abn),p53 wild type(p53wt).The general characteristics,tumor prognosis,and fertility outcomes between different molecular subgroups were analyzed and com-pared.Results:A total of 95 patients'pathological tissues at the first visit were examined,of which 2 were of POLE EDM subtype,25 of MMRd subtype,5 of p53abn subtype,and 63 of p53wt subtype.There was no statistically significant difference between MMRd type and p53wt type in general conditions,tumor prognosis,and fertility outcomes(P＞0.05).Subgroup analysis based on disease severity revealed that recurrence rates in the EC subgroup were 66.7%for MMRd patients and 16.7%for p53wt patients(P=0.019).In the AEH subgroup,pregnancy rates were 18.2%for MMRd patients and 71.4%for p53wt patients(P=0.006),showing sta-tistically significant differences.When considering different treatment methods,complete re-sponse rates after 9 months of oral high-potency progesterone treatment were 50.0%for MMRd patients and 82.9%for p53wt patients,with a statistically significant difference(P=0.046).Conclusion:Molecular classification is feasible for the evaluation of patients with early EC and AEH prior to fertility-preserving treatment.Both MMRd and p53wt subtypes demonstrate favora-ble prognosis and fertility outcomes following fertility-sparing treatment,with p53wt subtype pos-sibly providing greater benefit.